Nursing Informatics Annotated Bibliography and Critique

Historical Leadership and Innovation in Nursing

Harris, R., Bennett, J., and Ross, F. (2013). Leadership and innovation in nursing seen through a historical lens. Journal of Advanced Nursing, 70(7), 1629–1638.

There was a time when technology was a distant vision in the minds of healthcare professionals, but the values that emerged from nurses nearly a hundred years ago are values that should be alive and well today, notwithstanding all the remarkable tools available to the healthcare field now. This peer-reviewed article looks into the past to examine how nurses in the UK responded qualitatively to the leadership style of Dame/Matron Muriel Powell between the years 1920 and 1980 — well before today's nurses were empowered with the advanced technologies and communication standards of the present. The point of the research is to review interviews conducted with nurses who worked and trained at St. George's Hospital during that period.

Why were these interviews relevant in 2013, when the article was published? A look at how nursing used to be practiced, juxtaposed with today's cutting-edge, patient-centered technologies, is a worthy subject to explore. The interview transcripts of 132 nurses were "analyzed in depth" (between March 2011 and January 2012), and the themes that emerged reflected the very strong leadership Matron Powell displayed. The findings showed that through Powell's hands-on leadership and open communication, nurses under her guidance learned how to innovate when change was needed in the workplace. The interviews indicated that Powell created a hospital culture resulting primarily from her transformational leadership.

The strength of this article is its demonstration that staff morale is far better and patient outcomes are more positive when nurses are guided by strong leadership — a lack of leading-edge technology notwithstanding. There are many theories available on the best way to develop nurses, but one thing never changes, according to Harris and colleagues: the exercise of leadership from a position of influence and power is absolutely pivotal when it comes to developing competent nursing practices and building highly capable nurses. Another strength is that leading nursing figures from the past should be referenced, and the skills demonstrated by nursing leaders of previous eras can be — and often are — entirely germane to today's nurse. No notable weaknesses were identified. A highlight of the article is passages from the historical transcripts, such as: "I remember Matron Powell saying that it was better for granny to see her grandchildren on the ward than it was to give her a pint of blood" (Harris et al., 2013).

This was an excellent piece of research and should be required reading for all nurses in training, whether at hospitals or universities. Looking into the positives of the past is a fine way to strengthen the present and future for both nurses and patients.

Saifan, A., AbuRuz, M. E., and Masa'deh, R. (2015). Theory practice gaps in nursing education: A qualitative perspective. Journal of Social Sciences, 11(1), 20–29.

This article in the Journal of Social Sciences addresses the question of which is more important in nurse training — theory presented in a college or university setting, or clinical training. Of course both aspects of nurse training are vital, and without nursing informatics presented in clinical environments, would-be nurses today are missing out on the technology revolution and are unable to give patients the cutting-edge care they deserve. The main finding of the article is that nursing instructors are starting to adapt to the idea that the theoretical part of training is gaining emphasis while clinical training is receiving less focus. At some point in the recent past, it is believed there has been a lack of good communication between instructors from the theory school and those from the clinical school, which the authors suggest is part of the problem.

Theory-Practice Gaps and Emerging Educational Technologies

Nursing students, the authors assert, have become frustrated and dissatisfied because of insufficient reported support in the clinical training environment. The upshot of the article is that when 500 nursing students were interviewed in their final year of training, the majority reported a lack of emphasis given to "practice education"; the majority also reported that the clinical portion of their training was "complicated and continuously changed" (Saifan, 2015, p. 21).

One weakness evident in this piece is the style of reporting on what various students responded when asked about theory versus clinical training. Talk to any five students about the way in which they learn best and you will likely get five different viewpoints. A strength of this article is simply that it opens an intelligent discussion about which aspect of learning — theoretical education or clinical training — should receive the most emphasis in nursing programs.

This article has value because the debate about the best training for nurses is important. Clearly there is a gap between theory and practice, but there always has been and likely always will be. This piece could be summed up by the old adage, "Nothing new under the sun."

Skiba, D. J. (2015). Emerging technologies center / on the horizon: Implications for nursing education. Nursing Education Perspectives, 36(4), 263–266.

Nursing education could well be — and is beginning to be — positively impacted by the revolution in teaching technology. This article presents the results of the 2015 Horizon Report, compiled by the New Media Consortium and the Education Learning Initiative, which projects technology trends, the challenges associated with those trends, and which technologies are coming into use to aid education. Higher education, including nursing education, is evolving into a digital world where students will not always have to attend university classes in person but will instead be online, using dashboards to improve their learning. The main findings include news for nursing: NEXus (Nursing Education Xchange), which was launched in the 2000s as a way to share doctoral courses, is today used by schools all over the United States.

A clear strength of this article is the update it provides on distance education and how it applies to nursing education and other disciplines. Nursing students will in the near future be using "hypersituation," meaning they will carry devices with them "to help facilitate their problem-solving and decision-making" (Skiba, 2015, p. 3). Teachers will no longer need to search student-to-student to ensure patient safety. Certain objects in a patient's room will alert nurse students to patients' preferences for their care and their specific concerns. The one weakness is that the article did not delve deeply enough into the advantages that digital and distance learning will provide to nurses on duty as well as those still in school.

Ironside, P. M. (2015). Narrative pedagogy: Transforming nursing education through 15 years of research in nursing education. Nursing Education Perspectives, 36(2), 83–88.

The main point this author makes is that while narrative pedagogy has been used by teachers of myriad subjects around the world for more than fifteen years, very few innovations or pedagogies have been practiced by nursing educators (Ironside, 2015). This article examines the literature regarding nursing education and asserts that nursing educators should be embracing many pedagogies that "fundamentally transform" the interaction and relationships between clinicians, students, and nursing instructors. A variety of pedagogies should be included in any faculty member's teaching portfolio. Moreover, Ironside asserts that if nursing educators created refreshing approaches to subject matter, better-prepared nurse students would result. Narrative pedagogy is not just about sharing stories or offering examples; it is about "drawing attention to what stood out as important to nurses in particular situations" (Ironside, 2015).

Narrative Pedagogy, Nurse Education Policy, and Workforce Shortages

Because not everyone reading this article would immediately be familiar with narrative pedagogy, Ironside might have opened with a full explanation of the term. Eventually the author does explain that it is a "phenomenological" teaching method in the field of nursing. However, there are passages that are more esoteric than substantive in terms of commonly understood nursing concepts. On the other hand, the article's strength lies in the author's effort to shake things up in the academic world of nurse training.

There are valuable ideas presented in this article, and the author clearly engaged in a philosophically inspired approach to creative communication and curriculum within nursing education. The fact that there is no single correct way to provide instruction to nurses as they progress through training is presented toward the end of the article — and while it might have been introduced earlier, it is germane to the concept of narrative pedagogy.

Snow, T. (2012). Willis review of nurse education backs shift to all-graduate entry. Nursing Standard, 27(10), 6–7.

A major report issued in England — an investigation into the quality of nurse education — concluded that there are few shortcomings in the education of nurses in the UK. At least, the report asserts, there are no gaps in the quality of nurse education that could explain the "perceived decline" in nurse standards. The 55-page report produced 29 recommendations to improve nurse education; although some of them appear obvious, others involve an upgrade in the technologies that nurses need and that the healthcare industry should be embracing. What the report seems to represent, in reality, is a way to polish the somewhat tarnished image of the nursing field in England, where the public perception of nursing had reportedly slipped.

There is little value in reviewing recommendations that appear superficial or serve mainly as filler, but several substantive recommendations stand out: (a) healthcare workers who support trained nurses must be certified and regulated; (b) clear standards on public and patient involvement should be fully implemented; (c) a streamlined approach to regulating and evaluating nursing educators should be adopted; (d) a nursing career framework should be established for those considering entering the field; and (e) a means of stopping the declining numbers of available nurses must be found and implemented. As for weaknesses, one example stands out as a public relations measure intended to reassure the public: "Campaigns to promote understanding of nursing should be established" (Snow, p. 6).

It is educational to see what independent commissions produce when tasked with evaluating nursing education and clinical competency. For that reason, this article and report had merit. A sidebar story features quotes from various UK healthcare officials; National Health Service Employers director Dean Royles stated: "Regulation does not guarantee compassion. Let us not confuse being unregulated with being untrained" (Snow, p. 7).

Gillen, S. (2014). Investment in return to practice courses could solve nurse shortage. Nursing Standard, 28(25), 14–15.

The nursing shortage is a universal issue, and the UK, the US, Australia, and other countries all face critical demand for new nurses. This article discusses ways in which former nurses may be encouraged to return to their field. One major challenge with bringing retired nurses back is the need to re-qualify. This UK-based article explains that return to practice (RTP) courses must be taken to update returning nurses and ensure they meet current clinical standards — a requirement also in place in the United States. The article reviewed 34 universities in England to determine how many offered RTP courses and found that 40% did not. Meanwhile, of 748 former nurses who applied for and enrolled in RTP courses, 263 did not pass or dropped out.

The essence of the article is that funding is needed for retired nurses who wish to reenter the profession, and that a placement challenge arises when returning nurses must compete with newly trained graduates seeking positions. Gillen provides a rationale for resolving this issue and argues clearly that the industry must make allowances for returning nurses once they pass the required courses.

The strength of this piece is that it clearly identifies one possible solution to the nursing shortage and makes plain the challenges returning nurses face. A sidebar story featuring former nurse Tom Bolger's account of the difficulties he encountered when attempting to reenter nursing is as poignant and relevant as the main article itself. Because of the inflexibility of the process for returning nurses, Bolger was able to find a hospital that designed a "three-month course to suit his needs," and he successfully returned to nursing, including learning to put on gloves "every time when doing injections" (Gillen, p. 15). No notable weaknesses were found; the article was straightforward and factual.